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E/M Coding: Latest Updates for 2023


Evaluation and management (E/M) coding is a complex and ever-changing process. In order to ensure accurate reimbursement, it is important for physicians and other healthcare providers to stay up-to-date on the latest updates.

Here are some of the key changes to E/M coding in 2023:

  • New code for prolonged services: The CPT code 99418 has been added to report prolonged services in the inpatient setting. This code is used when the physician spends more than 54 minutes on the day of the encounter.

  • Updates to the MDM tables: The MDM tables have been updated to reflect the changes to the E/M documentation guidelines. The new tables provide more specific guidance on how to assess the MDM for each level of E/M service.

  • Changes to the time requirements: The time requirements for some E/M codes have been changed. For example, the time requirement for code 99215 has been increased from 40-54 minutes to 55-69 minutes.

These are just a few of the key changes to E/M coding in 2023. For more information, please consult the AMA's CPT coding guidelines.

In addition to the above changes, there are a few other things to keep in mind for E/M coding in 2023:

  • The use of time is still important in determining the level of E/M service, but it is no longer the sole factor.

  • The documentation requirements for E/M codes focus on the MDM and the complexity of the patient's problem(s).

  • The complexity of the patient's problem(s) is determined by the number and severity of the presenting problems, the risk of complications or comorbidities, and the need for additional testing or procedures.

By understanding the latest updates to E/M coding, physicians and other healthcare providers can ensure that they are accurately coding their services and receiving the appropriate reimbursement.

If you have any questions about E/M coding, please consult with your billing or coding specialist.

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